CAJ | 학술논문

目的比较MMSE和MoCA在社区老年人中MCI及痴呆筛查的准确度、敏感度和特异度等.方法采用分层整群抽样方法,在广州地区抽取8个居(村)委会,对其所属年龄≥65岁老年人采用MMSE、MoCA、听觉词语学习测验等进行认知功能测评.采用临床痴呆评定量表评定认知功能损害程度,社会功能活动调查量表评定其生活功能状态.对完成测查的2 111例老年人参照Petersen及DSM-Ⅳ的诊断标准根据其认知功能受损程度分为对照组、MCI组、痴呆组.绘制受试者工作特征曲线及曲线下面积分析各量表诊断MCI或痴呆的准确度,及其相应的敏感度与特异度.结果 MMSE和MoCA筛查MCI或痴呆的曲线下面积范围0.72～0.99,曲线下面积与完全随机情况下获得的Az =0.5比较,差异均有统计学意义(Z=2.75,P＜0.01);在MCI和痴呆筛查中,对不同文化程度人群MMSE较MoCA具有更大的曲线下面积,但两者比较差异无统计学意义;MCI筛查时,MMSE和MoCA在文盲、小学、中学文化及以上组的临界值及其相应的敏感度和特异度分别为21分(84％/64％)与15分(88％/54％)、26分(91％/70％)与20分(94％/68％) 、27分(93％/86％)与23分(93％/80％);痴呆筛查时,MMSE和MoCA在文盲、小学、中学文化及以上组的临界值及其相应的敏感度和特异度分别为16分(98％/85％)与11分(98％/70％)、20分(100％/94％)与14分(100％/87％)、22分(100％/98％)与16分(100％/95％).结论 MMSE和MoCA在MCI或痴呆筛查中均有较高的准确度、敏感度及特异度,但不同文化程度临界值不同.在MCI和痴呆的社区调查中,应分别采用MoCA及MMSE作为筛查工具.
목적 비교MMSE화MoCA재사구노년인중MCI급치태사사적준학도、민감도화특이도등.방법 채용분층정군추양방법,재엄주지구추취8개거(촌)위회,대기소속년령≥65세노년인채용MMSE、MoCA、은각사어학습측험등진행인지공능측평.채용림상치태평정량표평정인지공능손해정도,사회공능활동조사량표평정기생활공능상태.대완성측사적2 111례노년인삼조Petersen급DSM-Ⅳ적진단표준근거기인지공능수손정도분위대조조、MCI조、치태조.회제수시자공작특정곡선급곡선하면적분석각량표진단MCI혹치태적준학도,급기상응적민감도여특이도.결과 MMSE화MoCA사사MCI혹치태적곡선하면적범위0.72～0.99,곡선하면적여완전수궤정황하획득적Az =0.5비교,차이균유통계학의의(Z=2.75,P＜0.01);재MCI화치태사사중,대불동문화정도인군MMSE교MoCA구유경대적곡선하면적,단량자비교차이무통계학의의;MCI사사시,MMSE화MoCA재문맹、소학、중학문화급이상조적림계치급기상응적민감도화특이도분별위21분(84％/64％)여15분(88％/54％)、26분(91％/70％)여20분(94％/68％) 、27분(93％/86％)여23분(93％/80％);치태사사시,MMSE화MoCA재문맹、소학、중학문화급이상조적림계치급기상응적민감도화특이도분별위16분(98％/85％)여11분(98％/70％)、20분(100％/94％)여14분(100％/87％)、22분(100％/98％)여16분(100％/95％).결론 MMSE화MoCA재MCI혹치태사사중균유교고적준학도、민감도급특이도,단불동문화정도림계치불동.재MCI화치태적사구조사중,응분별채용MoCA급MMSE작위사사공구.
Objective To compare the accuracy,sensitivity,specificity of the Mini-Mental State Examination (MMSE) and Montreal cognitive assessment (MoCA) in screening of mild cognitive impairment (MCI) and dementia in community survey.Methods This study was conducted among residents aged 65 years and above in the urban and rural areas selected by stratified sampling from 6 urban and 2 rural communities.The 2 111 cases who finished the Neuropsychological tests included MMSE,MoCA,and Clinical Dementia Rating scale(CDR) were divided into groups normal control,MCI,and dementia.The accuracy,sensitivity and specificity was compared by the area under the curve (AUC) of receiver-operating characteristic curve.The clinical diagnoses of MCI was made according to Petersen's criteria.Results The areas under curve were between 0.72 to 0.99 for MMSE and MoCA on discriminated MCI or dementia (Z =2.75,P ＜0.01) when compared with Az =0.5 by random.In elders with different education levels,MMSE showed no significanlty larger AUC than MoCA in MCI or dementia screening (P ＞ 0.05).In MCI survey,the cutoff values and sensitivity/specificity of MMSE vs.MoCA in education levels of illiterate,primary,secondary and above were 21 (84 ％/64 ％) vs.15 (88 ％/54 ％),26 (91％/70％) vs.20 (94 ％/68 ％),27 (93％/86％) vs.23(93％/80％) respectively; but in dementia survey,the cutoff values and sensitivity/ specificity of MMSE vs.MoCA in education levels of illiterate,primary,secondary and above were 16 (98％/ 85％) vs.11 (98％/70％),20(100％/94％) vs.14(100％/87％),22(100％/98％) vs.16(100％/95％) respectively.Conclusions MMSE and MoCA are good cognitive assessment tools in the survey of MCI or dementia with high accuracy,sensitivity and specificity.But the cutoff value is different according to one's education level.MoCA may be more suitable for MCI survey but MMSE for dementia.